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What is the brachial plexus? 

The brachial plexus is a network of nerves in the neck and shoulder region (see the diagram below). It is made up from 5 large nerves which come out of the spinal cord between the vertebrae (bones in the neck), pass under the clavicle (collar bone) and into the upper arm. These nerves enable the signals that allow movement and feeling to reach the arm. These nerves are represented in speech and writing by these symbols: C5, C6, C7, C8, T1 (C=cervical, T=thoracic)


What are nerves and the nervous system?

Nerves are cord like structures of tissue formed from a collection of nerve fibers. A single nerve may contain thousands of fibers (a bit like an electrical cable). In the arm, these fibers carry electrical messages both ways between the brain, muscles and tissues. For a muscle to work (contract), a message must travel from the brain, along a nerve that goes directly to the muscle. When nerve fibers are injured, the muscles that the nerve controls may be weakened, even though the injury is not in the muscle itself.

The nervous system integrates all body activities by sensing changes (sensory function), interpreting those (integrative function) and reacting to them (motor function). Sensory neurons carry sensory information into the brain and spinal cord. Motor neurons carry information from the brain and spinal cord into the peripheral nerves. A neuron (or nerve cell) processes and transmits information by electrical or chemical signaling. 


What are the Causes of BPI?

Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:

  1. Contact sports: During football, players can experience stretching to the brachial plexus beyond their limit during collisions with other players.
  2. Difficult births:  New born babies can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor. If an infant’s shoulders get wedged within the birth canal, there is an increased risk of brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb’s palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.
  3. Trauma: Noncancerous (benign) or cancerous tumors can grow in the brachial plexus or put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
  4. Radiation treatment: Radiation treatment may cause damage to the brachial plexus.

What happens when there is an injury of the brachial plexus? 

Many factors affect how severe the injury to the brachial plexus may be. These depend on:

  1. The number of nerves affected: This varies between patients. Sometimes only one or two nerves are damaged resulting in loss of movement in one area, e.g. shoulder or elbow. In some cases, all the nerves are damaged causing complete loss of movement and feeling in the arm.
  2. How badly the nerves have been damaged: There may be mild stretching or compression of nerves. However, in more severe injuries, nerves may be torn apart by severe stretching. Deep wounds may cut through the nerves.

How do I know how severe the brachial plexus injury is? 

We may be able to determine the degree of damage to the nerves by examining you. However, it is quite common for other tests to be done to help tell us where the nerve injury is and how bad it is. These tests may include:

  1. MRI scan – this will provide information about the number of nerves damaged, spinal cord injury and formation of a swelling in the covering of the spinal cord. 
  2. Neurophysiology – recording of the passage of electrical signals along nerves in the limbs using small electrical pulses on your skin. The test may include a recording of the electrical activity of muscles which involve using fine needles. These tests can be used to diagnose a variety of nerve or muscle problems. 

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